Counts Christopher J, Skordis-Worrall Jolene
UCL Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
UCL Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, UK.
Health Policy Plan. 2016 May;31(4):434-43. doi: 10.1093/heapol/czv081. Epub 2015 Aug 28.
Despite the growing chronic disease burden in low- and middle-income countries, there are significant gaps in our understanding of the financial impact of these illnesses on households. As countries make progress towards universal health coverage, specific information is needed about how chronic disease care drives health expenditure over time, and how this spending differs from spending on acute disease care.
A 19-year panel dataset was constructed using data from the Kagera Health and Development Surveys. Health expenditure was modelled using multilevel regression for three different sub-populations of households: (1) all households that spent on healthcare, (2) households affected by chronic disease and (3) households affected by acute disease. Explanatory variables were identified from a review of the health expenditure literature, and all variables were analysed descriptively.
Households affected by chronic disease spent 22% more on healthcare than unaffected households. Catastrophic expenditure and zero expenditure are both common in chronic disease-affected households. Expenditure predictors were different between households affected by chronic disease and those unaffected. Expenditure over time is highly heterogeneous and household-dependent.
The financial burden of healthcare is greater for households affected by chronic disease than those unaffected. Households appear unable to sustain high levels of expenditure over time, likely resulting in both irregular chronic disease treatment and impoverishment. The Tanzanian government's current efforts to develop a National Health Financing Strategy present an important opportunity to prioritize policies that promote the long-term financial protection of households by preventing the catastrophic consequences of chronic disease care payments.
尽管低收入和中等收入国家的慢性病负担日益加重，但我们对这些疾病对家庭的经济影响的了解仍存在重大差距。随着各国在实现全民健康覆盖方面取得进展，需要具体信息来了解慢性病护理如何随时间推移推动医疗支出，以及这种支出与急性病护理支出有何不同。
利用卡盖拉健康与发展调查的数据构建了一个19年的面板数据集。使用多水平回归对三类不同的家庭亚群体的医疗支出进行建模：（1）所有有医疗支出的家庭；（2）受慢性病影响的家庭；（3）受急性病影响的家庭。从对医疗支出文献的回顾中确定解释变量，并对所有变量进行描述性分析。
受慢性病影响的家庭在医疗保健方面的支出比未受影响的家庭多22%。灾难性支出和零支出在受慢性病影响的家庭中都很常见。受慢性病影响的家庭和未受影响的家庭的支出预测因素不同。随着时间的推移，支出高度异质且因家庭而异。
受慢性病影响的家庭的医疗负担比未受影响的家庭更大。家庭似乎无法长期维持高水平的支出，这可能导致慢性病治疗不规律和贫困。坦桑尼亚政府目前制定国家卫生筹资战略的努力提供了一个重要机会，可优先制定政策，通过防止慢性病护理支付的灾难性后果来促进家庭的长期财务保护。
